November 2020 - Dr. Sharon Saline

Gratitude in an Age of Uncertainty

It’s clear that this holiday season won’t look like anything we’re accustomed to. Unable to gather safely with beloved family and friends, many of us (myself included) are planning for much smaller dinners. With all of the uncertainty we’ve been facing as individuals and as a country, it’s more important than ever to teach and practice gratitude for what we have and what’s gone well. How can you do this when you (and your family) may be frustrated, disappointed and anxious?

Gratitude: Thankful

The Cambridge Dictionary defines gratitude as “a strong feeling of appreciation to someone or something for what the person has done to help you.” I like this definition because it’s grounded in human relationships, and is more specific than ‘being thankful.’

For some people, it may be easy to feel generally thankful. For others, it may be tougher. Perhaps someone you care about has been sick or died; your children are struggling with remote/hybrid school; or you are dealing with food, housing or job insecurity. Whatever your particular situation may be, shifting the focus and noticing how someone has helped in recent months may open your eyes and your heart to a more accessible type of gratitude.

Expressing appreciation can lead to stronger relationships

In our crazy busy lives, we may toss a perfunctory ‘thank you’ for a small act of kindness without wholeheartedly expressing it. Though we may value a patient teacher, an attentive nurse or a competent mechanic, we often don’t take the time to let them know. I believe that the holiday season, starting with Thanksgiving and continuing on through the New Year, offers us an opportunity to express genuine gratitude with people who have touched our lives.

Children and teens with ADHD, who may miss social cues or be unaware of how their actions impact others, really benefit from slowing down and taking stock of helpers in their lives. Teaching kids to notice how people treat them and how to acknowledge consideration and generosity shows them that these qualities matter. They learn compassion, understanding and empathy.

Here are a few tips to practice gratitude in your family this year:

1. Notice what you have, not what you don’t.

We all can live in the ‘shoulds’ and ‘wants’. “I should be able to do X.” “I want a new phone.” When your son or daughter rails on how unfair it is that they don’t have this or that, trying to convince them otherwise wastes your time and energy. Instead of lecturing them and going negative yourself, take a deep breath, validate their longing and encourage them to keep a list of what they want for the future. Try not to engage but, if you must say something, remind them to focus on what they have and set goals for getting what they want.

2. Build awareness of gratitude: A family activity

Grab a stack of Post-Its or scrap paper, and gather your kids together for a 15 minute activity. Ask them to write down 3 specific things in their lives that they appreciate. From sports teams, to their iPad, to hot showers–anything is acceptable.

Next, ask them to connect those items to the person who made sure they happened or provided them. Post these on a large piece of paper, bulletin board or wall in a common area, such as the kitchen or living room. This activity helps your kids see that the cool stuff in their lives is linked to real people.

3. Express gratitude, simply or creatively:

Similar to learning how to give an authentic apology, kids with ADHD may not express appreciation as we typically expect. While eye contact and a heartfelt ‘thank you’ are ideal, your child or teen may do better with writing or expressing their gratitude in other ways.

Consider doing something fun this holiday: Write everybody’s name down on separate pieces of paper. Then, place them in a hat. Have each family member pick a name, and then write or draw a thank you note for an act of kindness that person has shown during the past week, month or year. Place these notes on plates, and open them together before your meal.

The day after Thanksgiving is also a holiday

The day after Thanksgiving is often filled with Black Friday shopping. But, it’s also a holiday. On October 8, 2008, President George W. Bush signed The Native American Heritage Day bill into law. This day is designated to pay tribute to Native Americans and their important legacy. Consider taking a few minutes to talk with your children about these contributions and how they have enriched our lives.

Read more blog posts:

Source: Meaning of gratitude in English. Cambridge English Dictionary. (n.d.). Retrieved December 20, 2021, from https://dictionary.cambridge.org/us/dictionary/english/gratitude

ADDitude Mag: Why Does Fear of Failure Cripple My Teen with ADHD?

Is your teen easily discouraged? Do they avoid activities where “success” isn’t guaranteed? These signs typically point to low self-esteem, likely developed due to years of negative messaging — common among individuals with ADHD. Here’s how to help your teen overcome a fear of failure. Click logo below to read more.

HealthCentral: Let’s Talk About ADHD in Children

“A recent study in JAMA reports that roughly 10% of all kids have ADHD. That means about one in 10 children in the U.S. is dealing with this challenging condition, making it one of the most common neurodevelopmental disorders children and teens face today. But at the same time, about 70% of Americans also believe that ADHD is overdiagnosed, according to a 2019 Harris Poll survey. That perception creates a whole lot of uncertainty for parents who are scratching their heads wondering if their child does, in fact, have a clinical condition or whether their behavior is just part of being a kid. Here, a bit of clarity.” Click logo below to read more.

Reducing Teen Stress and Anxiety during Pandemic

The Enormity of the COVID19 Experience

My heart goes out to teens and young adults. Staying compassionate, offering to collaborate on tasks and being available to talk through emotions is critical in reducing teen stress and anxiety during this pandemic. Don’t try to solve issues. Offer suggestions and avoid getting hurt if they aren’t taken. Young adults often like to figure things out for themselves, which means trial-and-error learning. Sometimes the best support you can give is managing your own frustrations, sharing your feelings without blame or guilt and validating their successes.

Strategies and Practical Approaches that WORK

Help teens acknowledge these uncomfortable feelings without trying to fix them – It’s natural to have low morale and feel stuck right now. This situation is no one’s fault and everybody is trying hard to manage the best they can. Focus on building their resilience. Consider past difficulties and reflect on how they overcame them. Explore how those strategies could apply to current challenges. Write these strategies down so teens can refer to them later.
Set realistic and appropriate goals – Teens may not be able to concentrate with hybrid learning as well as they have in the past. Keeping that in mind, work together and come up with do-able daily and/or weekly routines. Collaborate on a daily schedule that includes timed work and break periods, exercise, physical distance socializing and screen-free times. Having a reliable routine will keep kids grounded and on track. It helps them with predictability in these uncertain times.
Instill gratitude – every day, no matter how small, find one thing to be grateful for. Eating a yummy dinner, FaceTiming with a dear friend or playing a fun video game. It’s easy for teens to dismiss what they have in favor of longing for what they don’t. Help them shift their perspective to see the positive things that are going on instead of focusing on the things they are missing.
Wonder instead of worry – When teens don’t know what to expect and feel perpetually uncertain, their anxiety increases. In these times, they’re likely to act out because they may not have the language to express the combination of anger, frustration, sadness and worry that’s underneath their behavior. Help them tolerate the insecurity and pivot. Being curious instead of worrying means wondering about possible outcomes from a place of confidence that they can handle whatever arises.

To be honest, I used mental health days with my daughter when she was a teenager. About twice a semester, she would hit a wall: she needed sleep and some down time to get her head back in the game. So, we periodically gave her a “Sick-and-Tired” day off from school. It wasn’t planned but we had agreed as a family in advance that she could have 2 such days per semester. It was a successful collaboration: she felt that she got the mental health day she needed and we saw a positive difference when she returned to school.

Deeper Dive:

https://drsharonsaline.com/2020/06/30/whats-a-normal-level-of-anxiety/ https://drsharonsaline.com/2020/03/10/kids-and-mental-health-days/

22 News Mass Appeal: Tips to Make Online Learning Easier

With the cold weather approaching and COVID numbers rising, parents are facing the added responsibility of supporting our children’s online learning. Clinical Psychologist Dr. Sharon Saline, of doctorsharonsaline.com, joins us with four tips to help children and teens with school work. Click logo below to read more.

HealthCentral: Let’s Talk About How ADHD Is Diagnosed

“Here’s the thing: There are no blood tests or scans or any type of online screener to accurately diagnose Attention-Deficit/Hyperactivity Disorder (ADHD). In short, sussing out ADHD is not a quick and easy process. However, with the right know-how, you can navigate this new-to-you world and gather the intel you need to either help your child or yourself move on to the next step: Treatment.” Click logo below to read more.

How ADHD Is Diagnosed

This content is excerpted from HealthCentral on How ADHD Is Diagnosed. I am one of the panel experts, along with Russell A. Barkley, Ph.D.Clinical Professor of Psychiatry and Rosemarie Manfredi, Psy.D. Licensed Psychologist and Certified School Psychologist Let’s Talk About How ADHD Is Diagnosed How ADHD Is Diagnosed. There’s no single test that can determine if you or your child has ADHD, but we’ll help you get the answers you’re seeking. First, What Exactly Is ADHD?

ADHD is one of the most prevalent neurodevelopmental disorders of childhood. It can continue well into the adult years. ADHD is marked by:

Inattention (wandering off task, loss of focus, disorganization)
Hyperactivity (being in constant motion)
Impulsivity (acting or speaking without thinking)

People with ADHD may have one of these signs or symptoms, or a combination. Most kids have the type of ADHD that’s a combo of symptoms. More than 6 million children have been diagnosed with ADHD. Roughly 11 million people, or 5 percent of the adult population, have it, too according to a 2016 report from the Centers for Disease Control and Prevention (CDC).

Who Diagnoses ADHD?

ADHD can’t be diagnosed based on a 15-minute checkup. A proper ADHD diagnosis involves interviews with the person and their parents or other loved ones—and teachers, if applicable. There are checklists, observations, official questionnaires and a medical evaluation, too. Before calling on a trained ADHD expert, know this: Only medical professionals, like physicians and nurse practitioners, can perform a thorough physical evaluation to rule out other possible medical causes of ADHD-like symptoms. As part of a complete check-up, you or your child should get a vision and hearing test. Your physician may also screen for brain injuries, such as a concussion, and look for an underlying seizure or sleep disorder. In rare cases, individuals with ADHD-like symptoms may have thyroid dysfunction. If this is suspected, a blood panel may be ordered. At the same time, other conditions can masquerade as—or coexist with—ADHD. These include:

Developmental delays
Autistic spectrum disorder
Learning disabilities
Anxiety
Depression
Trauma
Bipolar disorder
Obsessive-compulsive disorder

According to the American Academy of Pediatrics, the majority of children diagnosed with ADHD also meet the diagnostic criteria for another mental health disorder. These types of issues are normally screened for during the next step of the ADHD diagnosis process: The comprehensive evaluation (also called a comprehensive assessment).

Read the HealthCentral Article

Additional Resources:

https://drsharonsaline.com/2020/10/02/video-going-back-to-school-w-dr-sharon-saline-debbie-reber/

ADHD Teens and Remote Learning: 5 tips for learning success

Has your ADHD teen hit a wall with remote learning? Many teens with ADHD in middle and high school are struggling with organization, initiation, time management and a limited capacity for self-evaluation. It’s tough as a parent of a teen to know how much involvement is appropriate and when it’s too much. Independent school work–whether it’s attending remote classes or doing homework–require most, if not all, of kids’ developing executive functioning skills. These skills need to be taught directly, and your teen can’t learn them on their own, despite whatever pushback they show you. Today I’m going to discuss how to strengthen a few of the key executive functioning skills needed for school success.

Collaborate with your ADHD teen about remote learning practices, and make a plan together.

First and foremost, you’ll need to co-create a plan with effective interventions to build these skills with less arguing. The key to creating any programs and having them last is to collaborate with your teen.

Set a time for a weekly family meeting.
At the meeting, pick ONE skill to address that you both agree on.
Then, brainstorm solutions and include at least one of their ideas in your new plan.
Prepare to tweak this plan at your weekly chat. As you live with some of these changes, they will likely need to be adjusted.

Finally, remember to validate and acknowledge ANY cooperation and progress towards the goal. When you notice their efforting, kids feel encouraged and will keep trying.

5 tips to help ADHD teens with remote learning challenges:

1. Prepare ADHD teens for the remote learning process

While you’re probably not trained as a teacher, and you may not understand the algebra that your teen is learning, you can still set up the home as a meaningful learning environment. Take some time to understand the online school platform. Make sure your teen does, too. They are agile with the internet, but not perhaps with the intricacies of this site.

Tip: Establish appropriate expectations.

Most teachers are very good at letting their students know what they anticipate from them. You must do the same thing.

If your teen has trouble with completing and submitting their work, set up a routine with the expectation that, at the end of doing homework, you see their finished work and confirm that it’s been uploaded correctly. Provide regular check-ins: ask if they are stuck on something and, if you can’t help them, brainstorm who can.

2. Organization:

Everything needs a place and that includes online materials. When a student attends school in-person, they have materials such as pencils or pens, notebooks, workbooks and textbooks. They store papers and worksheets for classes in folders or files. These materials may be messy or neat, but there’s usually some type of system.

Tip: Manage digital information in a systematic way.

Teens with ADHD need a similar storage system for remote learning: files and folders that are clearly marked and accessible for class materials, separate browsers for school and fun stuff and calendars for what’s due when.

These calendars can be digital or paper or both. A weekly online calendar with color blocks of what’s happening when, a whiteboard that changes weekly or a paper calendar with Post-Its of tasks will provide a map for your teen of what to do. Give extra time for organizing materials and work with what systems make sense to your teen (by color, subject, numerical, etc.)

3. Initiation:

Many teens with ADHD struggle with initiation and are excellent procrastinators. They simply can’t start with unpleasant or intimidating tasks, either because of the quantity of the task or its content. If something seems too overwhelming and unpleasant, they can’t get started due to three different types of procrastination:

- Perfectionism (“It’s got to be just so”)
- Avoidance (“I hate this”)
- Productive (“I’ll do something I like that I have to do instead of the important thing”).

Tip: Help ADHD teens with remote learning assignments by breaking them down and using incentives.

The greatest barrier to initiation is someone’s perception of the task. Most teens with ADHD can see the value of completing tasks, but they may well lack the interest, skill or focus to do it. Make tasks small enough that beginning them is within your teen’s reach. Instead of doing five math problems, start with one.

If your teen doesn’t understand the remote learning material, arrange regular help sessions with the teacher.

To promote follow through, set up timed work periods based on how long your teen can focus before distraction impacts their productivity. For example, maybe they work for 15 minutes, take a planned 5 minute break and work for another study period with another short break, and a final push before a bigger incentive/reward for their efforts.

3. Time management:

It’s very common for people with ADHD to experience time-blindness. They wrestle with how to feel and understand time. This challenge makes it harder for kids to estimate how long something will take and what they can do in a certain amount of time. This misunderstanding of time affects their capacity for organization and motivation. Luckily, time responds very well to direct instruction.

Tip: Make time physical, and use external alerts.

Use analogue clocks or timers to show kids how time moves. Instead of guessing about time, collect information by putting on your scientist’s cap. Post a simple chart of a few dreaded tasks, a guess about how long they will take and then a measurement of the amount of time it actually took. For three days, ask your teen (or work with them) to keep track of these, Then review your findings and adjust your weekly/daily calendar accordingly.

4. Self-evaluation:

Self-evaluation, also known as metacognitive awareness, is the last executive functioning skill to coalesce. Often, this happens in the mid-to-late twenties for people with ADHD. The term self-evaluation refers to the abilities for self-understanding, judgment and decision-making. It’s critical to develop this capacity for self-reflection as children mature. Teens who are naturally more self-focused are primed for this process. Better self-awareness fosters the academic and social competence they’ll need for adulthood. When kids understand what kinds of learners they are, they are more likely to feel more confident in their abilities and solve problems more effectively. This is important for adapting to new situations, such as teens with ADHD adjusting to remote learning.

Tip: Ask open-ended questions to guide self-reflection.

Instead of telling your teen what they’re not aware of, or how they could do something differently, ask them questions such as:

- - “What’s helped you before that you could apply to this situation?”
  - “What are some other choices you could make in the future in a similar experience?”
  - “When facing something that you dislike, what’s one strategy that works to get you started?”

Share some of your observations if they are stuck.